Your Digest for Wednesday, Dec 27, 2023 03:59 PM


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[!TIP] Patient (esp. Female) with abdominal pain + neuropsychiatric features -> need to consider acute porphyria.


    1. Overnight 1mg dexamethasone suppression test

Psoriatic arthritis is associated with HLA-B27.

Imaging

Psoriatic arthritis Vs. Rheumatoid arthritis

Differentiation is clinically important because prognosis and management are different.

PsA RA
better prognosis Somewhat worse
Early disease -> NSAIDS DMARDs started early
Dactylitis, enthesistis, tenosynovitis -
pattern: asymmetric oligo / symmetric, DIP is specific Symmetric polyarthritis of PIP / MCP
Sacroiliitis -
Nail changes -
- proximal hand and foot involvement (?wrist and ankles)
Source

Summary of enzymes involved

HMG-CoA reductase: Rate limiting enzyme in cholesterol sythesis : found in the liver and ? other tissues
LCAT : the enzyme synthesized by the liver and attached to HDL which exterifies cholesterol so that it becomes trapped inside HDL. Required for reverse transport of cholesterol.
LPL: lipoprotein lipase: the enzyme found on tissues which removes lipids from VLDL and it's derivatives, increasing their density.
If there is acidosis (pH < 7.2 or HCO3 < 15) or high ketonemia, manage as DKA.
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+ it is **non pruritic**, starts on the abdomen and **spreads *outwards***. (Spares palms and soles) 

Trombiculid mite = 'harvest' mite

Endemic typhus serves as the prototype for pathogenesis:
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[!INFO] DCT physiology

Inheritance: #autosomal-Recessive

These changes (except the lack of hyponatremia) are very similar to changes caused by chronic thiazide use.


8. Endocrine: reduced testosterone (due to Leydig cell dysfunction) [Source](https://emedicine.medscape.com/article/120858-overview)

Interface hepatitis is seen, just like autoimmune hepatitis.
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🔖Extrahepatic manifestations of hepatitis B



Symptoms : N/V, headache,
motor effects: nystagmus, tremor, cerebellar ataxia.

Phenytoin side effects

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Despite prominent anticholinergic toxicity in some, physostigmine is contraindicated (incr. risk of arrest)

Antipsychotic drugs

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Causes of hyperprolactinaemia

#2023GM-NOV/Q30
Pathological causes

Drugs: